Gadgetwise Blog: Print to Pixels: Picking an E-Reader

E-readers are not quite books, but most use some form of electronic ink to mimic books, right down to the ability to mark your place by virtually turning down page corners. The advantage over books is that you can carry a thousand tomes in a tiny reader, and search for passages as you would on a computer. Unlike on a computer, a battery charge can last weeks.

When it comes to pure e-readers, those monochromatic slates that are just for consuming books and magazines, there are still a lot of features to consider before you buy.

The first consideration is size. Which is more important to you, portability or large print? Screen sizes range from about 5 inches, around the size of a trade paperback, to about 10 inches, approximately the size of a hardback.

But the largest screens aren’t necessarily the easiest to read – there is also the matter of resolution, which affects how sharp the text looks. For instance, the Amazon Kindle Paperwhite has a 5-inch screen, but rivals 10-inch readers with its 1,024-by-758 screen resolution.

The readers have to connect to the Internet to download books, but the method affects the price. Wi-Fi-only models tend to be less expensive than those that also connect over the 3G phone network. The Paperwhite is available with Wi-Fi only for $120, or with a 3G connection for $180. The spontaneity of 3G’s ability to download books anytime and anywhere is attractive, but since the reader is estimated to hold more than 1,000 books at a time, with a little planning you won’t run out of reading material between nearly ubiquitous Wi-Fi hotspots.

Another consideration is if you like to read in the dark. Screens that are not illuminated, like that of the bargain $100 Nook Simple Touch require a light source, like a regular book. The similar Nook Simple Touch With Glowlight ($120) has its own light. But that will drain the battery more quickly.

There are readers with even more advanced features, like color screens – better for enjoying magazines – that allow readers to also watch video, listen to music, browse the Web and send e-mail. But arguably those machines, like the $200 Kindle Fire HD, cross the line from e-reader to tablet.

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Documents Show F.D.A.’s Failures in Meningitis Outbreak

Newly released documents add vivid detail to the emerging portrait of the Food and Drug Administration’s ineffective and halting efforts to regulate a Massachusetts company implicated in a national meningitis outbreak that has sickened nearly 500 people and killed 34.

In the documents, released on Tuesday in response to a Freedom of Information Act request, the agency would threaten to bring the full force of its authority down on the company, only to back away, citing lack of jurisdiction.

The company, the New England Compounding Center, at times cooperated with F.D.A. inspectors and promised to improve its procedures, and at other times challenged the agency’s legal authority to regulate it, refused to provide records and continued to ship a drug in defiance of the agency’s concerns.

Some of the documents were summarized last week by Congressional committees that held hearings on the meningitis outbreak. Republicans and Democrats criticized the F.D.A. for failing to act on information about unsafe practices at the company as far back as March 2002.

By law, compounding pharmacies are regulated primarily by the states, but the pharmacies have grown over the years into major suppliers of some of the country’s biggest hospitals. The F.D.A. is asking Congress for stronger, clearer authority to police them, but Republicans have said the agency already has enough power.

Records show that the agency was sometimes slow in pursuing its own inspection findings. In one case involving the labeling and marketing of drugs, the agency issued a warning letter to New England Compounding 684 days after an inspection, a delay that the company’s chief pharmacist complained was so long that some of the letter’s assertions no longer applied to its operations.

The agency said in a statement Wednesday that it “was not the timeline we strive for,” but that much of the delay was because of “our limited, unclear and contested authority in this area.” Because of litigation, it said, there was “significant internal discussion about how to regulate compounders.”

The agency first inspected the company in April 2002 after reports that two patients had become dizzy and short of breath after being injected with a steroid made by the company.

 On the first day of the inspection, Barry Cadden, the chief pharmacist, was cooperative, but the next day, the agency inspectors wrote, Mr. Cadden “had a complete change in attitude & basically would not provide any additional information either by responding to questions or providing records,” adding that he challenged their legal authority to be at his pharmacy at all.

The F.D.A. was back at New England Compounding in October 2002 because of possible contamination of another of its products, methylprednisolone acetate, the same drug involved in the current meningitis outbreak.

 While the F.D.A. had the right to seize an adulterated steroid, officials at the time said that action alone would not resolve the company’s poor compounding practices. In a meeting with Massachusetts regulators, F.D.A. officials left authority in the hands of the state, which “would be in a better position to gain compliance or take regulatory action,” according to a memo by an F.D.A. official summarizing the meeting.

 David Elder, compliance branch director for the F.D.A.’s New England District, warned at the meeting that there was the “potential for serious public health consequences if N.E.C.C.’s compounding practices, in particular those relating to sterile products, are not improved.”

 The company fought back hard, repeatedly questioning the F.D.A.’s jurisdiction. In a September 2004 inspection over concerns that the company was dispensing trypan blue, a dye used for some eye surgeries that had not been approved by the F.D.A., Mr. Cadden told the agency inspector that he had none in stock.

But in the clean room, the inspector noticed a drawer labeled “Trypan Blue,” which contained 189 vials of the medicine.

A few days later, Mr. Cadden was defiant. He told the agency that he was continuing to dispense trypan blue and that there was nothing in the law saying a compounder could not dispense unapproved products.

 The conversation turned testy. “Don’t answer any more questions!” Mr. Cadden told another pharmacy executive, according to the F.D.A.’s report.

Mr. Cadden rejected many of the assertions in the warning letter that finally came in December 2006. The next correspondence from the agency did not come until almost two years later, in October 2008, saying that the agency still had “serious concerns” about the company’s practices, and that failing to correct them could result in seizure of products and an injunction against the company and its principals.

It is not known whether any corrective actions were taken. The agency did not conduct another inspection until the recent meningitis outbreak.

Denise Grady contributed reporting.

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Documents Show F.D.A.’s Failures in Meningitis Outbreak

Newly released documents add vivid detail to the emerging portrait of the Food and Drug Administration’s ineffective and halting efforts to regulate a Massachusetts company implicated in a national meningitis outbreak that has sickened nearly 500 people and killed 34.

In the documents, released on Tuesday in response to a Freedom of Information Act request, the agency would threaten to bring the full force of its authority down on the company, only to back away, citing lack of jurisdiction.

The company, the New England Compounding Center, at times cooperated with F.D.A. inspectors and promised to improve its procedures, and at other times challenged the agency’s legal authority to regulate it, refused to provide records and continued to ship a drug in defiance of the agency’s concerns.

Some of the documents were summarized last week by Congressional committees that held hearings on the meningitis outbreak. Republicans and Democrats criticized the F.D.A. for failing to act on information about unsafe practices at the company as far back as March 2002.

By law, compounding pharmacies are regulated primarily by the states, but the pharmacies have grown over the years into major suppliers of some of the country’s biggest hospitals. The F.D.A. is asking Congress for stronger, clearer authority to police them, but Republicans have said the agency already has enough power.

Records show that the agency was sometimes slow in pursuing its own inspection findings. In one case involving the labeling and marketing of drugs, the agency issued a warning letter to New England Compounding 684 days after an inspection, a delay that the company’s chief pharmacist complained was so long that some of the letter’s assertions no longer applied to its operations.

The agency said in a statement Wednesday that it “was not the timeline we strive for,” but that much of the delay was because of “our limited, unclear and contested authority in this area.” Because of litigation, it said, there was “significant internal discussion about how to regulate compounders.”

The agency first inspected the company in April 2002 after reports that two patients had become dizzy and short of breath after being injected with a steroid made by the company.

 On the first day of the inspection, Barry Cadden, the chief pharmacist, was cooperative, but the next day, the agency inspectors wrote, Mr. Cadden “had a complete change in attitude & basically would not provide any additional information either by responding to questions or providing records,” adding that he challenged their legal authority to be at his pharmacy at all.

The F.D.A. was back at New England Compounding in October 2002 because of possible contamination of another of its products, methylprednisolone acetate, the same drug involved in the current meningitis outbreak.

 While the F.D.A. had the right to seize an adulterated steroid, officials at the time said that action alone would not resolve the company’s poor compounding practices. In a meeting with Massachusetts regulators, F.D.A. officials left authority in the hands of the state, which “would be in a better position to gain compliance or take regulatory action,” according to a memo by an F.D.A. official summarizing the meeting.

 David Elder, compliance branch director for the F.D.A.’s New England District, warned at the meeting that there was the “potential for serious public health consequences if N.E.C.C.’s compounding practices, in particular those relating to sterile products, are not improved.”

 The company fought back hard, repeatedly questioning the F.D.A.’s jurisdiction. In a September 2004 inspection over concerns that the company was dispensing trypan blue, a dye used for some eye surgeries that had not been approved by the F.D.A., Mr. Cadden told the agency inspector that he had none in stock.

But in the clean room, the inspector noticed a drawer labeled “Trypan Blue,” which contained 189 vials of the medicine.

A few days later, Mr. Cadden was defiant. He told the agency that he was continuing to dispense trypan blue and that there was nothing in the law saying a compounder could not dispense unapproved products.

 The conversation turned testy. “Don’t answer any more questions!” Mr. Cadden told another pharmacy executive, according to the F.D.A.’s report.

Mr. Cadden rejected many of the assertions in the warning letter that finally came in December 2006. The next correspondence from the agency did not come until almost two years later, in October 2008, saying that the agency still had “serious concerns” about the company’s practices, and that failing to correct them could result in seizure of products and an injunction against the company and its principals.

It is not known whether any corrective actions were taken. The agency did not conduct another inspection until the recent meningitis outbreak.

Denise Grady contributed reporting.

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Cease-Fire Deal Elusive in Gaza Conflict as U.S. Widens Its Role

JERUSALEM — To a backdrop of air strikes and mounting casualties, American efforts to negotiate a cease-fire in the latest Gaza fighting between Israel and Hamas continued onWednesday but the struggle to achieve even a brief pause in the fighting emphasized the obstacles to finding any lasting solution.

Israeli airstrikes overnight continued into Wednesday morning, hitting government buildings, the smuggling tunnels under the southern Rafah border crossing, and a bridge on the beach road that is one of three linking Gaza City to the central area of the strip. The Hamas healthy ministry said the Palestinian death toll stood at 140 at noon, with 1,100 injured. At least a third of those killed are believed to have been militants.

The eight-day conflict in the Gaza Strip also appeared to have spilled onto the streets of Tel Aviv on Wednesday with what police described as a bomb blast aboard a civilian bus. Eleven people were injured, one of them seriously.

The latest exchanges, which included the interception of at least two rockets fired from Gaza, came as Secretary of State Hillary Rodham Clinton was reported to have held talks with Palestinian leaders in the West Bank and Israeli leaders in Jerusalem. She was scheduled to fly on Wednesday to Cairo where Egyptian-brokered ceasefire talks have thus far been inconclusive.

Around noon on Wednesday in the Gaza Strip, according to the Hamas government media office, a bomb hit the house of Issam Da’alis, an adviser to Ismail Haniya, the Hamas prime minister. The house had been evacuated. Earlier, a predawn airstrike near a mosque in the Jabaliya Refugee Camp killed a 30-year-old militant, a spokesman said, and F-16 bombs destroyed two houses in the central Gaza Strip.

There were 23 punishing strikes against the southern tunnels that are used to bring weapons as well as construction material, cars and other commercial goods into Gaza from the Sinai peninsula.

Within Gaza City, Abu Khadra, the largest government office complex, was obliterated overnight. Damage was also caused to shops, including two banks and a tourism office, and electricity cables fell on the ground and were covered in dust.

Separately, an F-16 bomb created a 20-foot crater in an open area in a stretch of hotels occupied by foreign journalists. Several of the hotels had windows blown out by the strike around 2 a.m., but no one was reported injured. By morning, the hole in the ground had filled with sludgy water, apparently from a burst pipe, appearing almost like a forgotten swimming hole with walls made of sand and cracked cinder block.

Surveying damage near a government complex, Raji Sourani of the Palestinian Center for Human Rights said Gaza civilians were “in the eye of the storm,” accusing Israel of “inflicting pain and terror” on them. Israeli officials accuse Hamas of locating military sites in or close to civilian areas. 

Overnight, as the conflict entered its eighth day, the Israeli military said in Twitter feeds that “more than 100 terror sites were targeted, of which approximately 50 were underground rocket launchers.” The targets included the Ministry of Internal Security in Gaza, described as “one of the Hamas’ main command and control centers.”

While there was no immediate or formal claim of responsibility for the bus bombing in Tel Aviv, a message on a Twitter account in the name of the Al Qassam Brigades, the armed wing of the Hamas authorities in the Gaza Strip, declared: “We told you IDF that our blessed hands will reach your leaders and soldiers wherever they are, ‘You opened the Gates of Hell on Yourselves.’” The letters IDF refer to the Israel Defense Forces.

On several occasions since the latest conflagration seized Gaza last week, militants have aimed rockets at Tel Aviv but they have either fallen short, landed in the sea or been intercepted. Hundreds of rockets fired by militants in Gaza have struck other targets.

But the bombing seemed to mark the first time in the current fighting that violence had spread directly onto the streets of Tel Aviv.

On Tuesday — the deadliest day of fighting in the conflict — Secretary of State Clinton arrived hurriedly in Jerusalem and met with Prime Minister Benjamin Netanyahu of Israel to push for a truce. Her planned visit to Cairo on Wednesday to consult with Egyptian officials in contact with Hamas placed her and the Obama administration at the center of a fraught process with multiple parties, interests and demands.

Before leaving for Cairo, news reports said, Mrs. Clinton headed to the West Bank to meet Mahmoud Abbas, the head of the Palestinian Authority, which is estranged from the Hamas rulers of the Gaza Strip and has increasingly strained ties with Israel over a contentious attempt to upgrade the Palestinian status at the United Nations to that of a nonmember state. Mrs. Clinton was to meet again with Mr. Netanyahu before heading for Egypt, the reports said.

Ethan Bronner reported from Jerusalem, and David D. Kirkpatrick from Cairo. Reporting was contributed by Jodi Rudoren and Fares Akram from Gaza; Isabel Kershner from Jerusalem; Alan Cowell from London; Peter Baker from Phnom Penh, Cambodia; David E. Sanger and Mark Landler from Washington; Andrea Bruce from Rafah, and Rick Gladstone from New York.

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Gadgetwise Blog: Q&A: Deleting the Conversation in Word

How do I delete all the comments at once in a Word 2010 file?

The editing tools in most versions of Microsoft Word allow you to keep track of all the deletions and insertions in the document’s text, as well as embed personal comments for the people you are working with on the file. Word is set to display all of this editing and commentary by default to make sure a work-in-progress does not get sent around as the final document.

When it comes time to finalize the Word 2010 document, you can remove all of the embedded comments at once. Click a comment to select it and then click the Review tab up in the Office Ribbon. In the Comments area, click the arrow under the Delete icon and select “Delete All Comments in Document.” Microsoft has more information about working with Word comments on its site.

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The New Old Age Blog: Patience, Consciousness and White Lies

My wife and I are blessed with having three “semi-independent” parents in their mid-80s living within a few blocks of us. Our children grew up knowing their grandparents as integral parts of our nuclear family, within walking distance for most of their childhoods. But now that our nest is empty, we find ourselves reliving many of the parenting issues we faced when our children were little — now in geriatric versions, at close range. As it turns out, parenting was good practice for the issues we face with our own parents.

What exactly does semi-independence mean as applied to elderly parents? Among our three, we have two canes, five walkers, one wheelchair (for long walks), four artificial joints, a pacemaker, four hearing aides and a knee brace. The list of medical conditions is long, and the list of medications even longer, requiring different color pill box organizers for morning, afternoon and evening.

Our parents all live in the same homes they have been in for many years. Keeping them safe and healthy there, as well as when they leave the house, has become a big part of our day-to-day work these days. Therein the yin and yang of parenting has returned — independence versus helicoptering.

Children’s yearning for independence begins in toddlerhood: “I can do it myself!” It escalates through childhood, accelerates with the driver’s license, and crescendos, with pomp and circumstance, at high school graduation.

The urge for independence is seen in all animal species, but relinquishing independence and accepting assistance in old age is unique to humans. For most elderly, it comes with a struggle, reflecting how hardwired our brains are for independence. The thought of getting in-home help is antithetical to our parents’ sense of self worth, exceeded only by the dread of leaving their homes for assisted living facilities. So, as tasks that were once mundane and automatic have become onerous and stressful for them, we attempt to foster autonomy while protecting them from harm, as we did with our children just a few short years ago.

Childproofing – Our home has again become hazardous, as have theirs. Furniture must be rearranged, booster seats placed on chairs to ease standing up, slippery rugs removed, lighting improved, bathrooms accessorized with handles and rails.

Dressing – Body shapes change in childhood and in old age. Our parents’ wardrobes, like those of our children’s before them, need frequent attention to preserve self-esteem. Their unwillingness to part with old clothes turns us into tailors. And, once again, we shop for slip-on sneakers with Velcro ties.

Driving – For our teens, driving was the symbolic liberation from childhood to young adulthood. For our parents, driving is the symbolic resistance to infirmity and old age. Our attempt to wean them from their cars, in precisely the reverse order we used to phase our teens into driving, has been torture for our parents and for us.

Toys – We have filled our parents’ shelves with new toys to help them with everything from opening cartons of milk (I would like a word with whoever designed those plastic pull loops) and zipping their clothes, to opening jars and removing the protective seals from over-the-counter medicines. A “picker-upper” device helps them avoid bending too low, and a key turner gives them leverage to open their door. Large digital clock faces, easy-to-read telephone keypads, and magnifying glasses keep them in touch with the world, and an e-mail printer keeps them in touch with their grandchildren.

Medicating – Filling those plastic pill box organizers with a week’s worth of medicines has become a personal barometer of competence for our parents, yet, as with our children when they were young, we feel compelled to oversee the dosing.

Mobility – Despite numerous falls, it was only with much teeth gnashing (or denture gnashing, as the case may be) that our mothers consented to use canes; more gnashing when canes gave way to walkers. For long walks, we hide the wheelchair half way there and back so the neighbors don’t see.

The more we do for our parents, the more frail and guilty they feel. Our efforts are sometimes resented. Helping them get in and out of the car, or bracing them under the arm as they negotiate a bumpy sidewalk, can be an affront. “I can do it myself!”

Can I ride my bike to tennis practice if I’m really careful crossing Holly Street? Why can’t I take a cab home from the seniors program at the community center? Can I walk to grandma’s by myself this time? Can I take the bus to the supermarket today? Everyone is hanging out at the park after school, can I go? I’ll just walk down the block to the neighbor’s house this afternoon, O.K.?

What wisdom did we gain the first time around to help us now? Patience, consciousness and white lies.

Patience to wait for them to come to the same conclusions we did. Mom, do you think Rosalind would have fallen and broken both wrists if she had been using a walker?

Consciousness about their need for independence as ballast to our need for their well-being. Why don’t you just let us drive you at night for now?

And white lies: I’m going to the supermarket anyway, we can shop together.

The longer we can protect our parents from harm, the more we can share our lives with them and the more joy they can have from their grandchildren. The trick is doing it without hurting them in other ways.

We have been through this before. It was worth it then, and it is worth it now.

Dr. Harley A. Rotbart is professor and vice chairman of pediatrics at the University of Colorado School of Medicine and the author of “No Regrets Parenting.”

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The New Old Age Blog: Patience, Consciousness and White Lies

My wife and I are blessed with having three “semi-independent” parents in their mid-80s living within a few blocks of us. Our children grew up knowing their grandparents as integral parts of our nuclear family, within walking distance for most of their childhoods. But now that our nest is empty, we find ourselves reliving many of the parenting issues we faced when our children were little — now in geriatric versions, at close range. As it turns out, parenting was good practice for the issues we face with our own parents.

What exactly does semi-independence mean as applied to elderly parents? Among our three, we have two canes, five walkers, one wheelchair (for long walks), four artificial joints, a pacemaker, four hearing aides and a knee brace. The list of medical conditions is long, and the list of medications even longer, requiring different color pill box organizers for morning, afternoon and evening.

Our parents all live in the same homes they have been in for many years. Keeping them safe and healthy there, as well as when they leave the house, has become a big part of our day-to-day work these days. Therein the yin and yang of parenting has returned — independence versus helicoptering.

Children’s yearning for independence begins in toddlerhood: “I can do it myself!” It escalates through childhood, accelerates with the driver’s license, and crescendos, with pomp and circumstance, at high school graduation.

The urge for independence is seen in all animal species, but relinquishing independence and accepting assistance in old age is unique to humans. For most elderly, it comes with a struggle, reflecting how hardwired our brains are for independence. The thought of getting in-home help is antithetical to our parents’ sense of self worth, exceeded only by the dread of leaving their homes for assisted living facilities. So, as tasks that were once mundane and automatic have become onerous and stressful for them, we attempt to foster autonomy while protecting them from harm, as we did with our children just a few short years ago.

Childproofing – Our home has again become hazardous, as have theirs. Furniture must be rearranged, booster seats placed on chairs to ease standing up, slippery rugs removed, lighting improved, bathrooms accessorized with handles and rails.

Dressing – Body shapes change in childhood and in old age. Our parents’ wardrobes, like those of our children’s before them, need frequent attention to preserve self-esteem. Their unwillingness to part with old clothes turns us into tailors. And, once again, we shop for slip-on sneakers with Velcro ties.

Driving – For our teens, driving was the symbolic liberation from childhood to young adulthood. For our parents, driving is the symbolic resistance to infirmity and old age. Our attempt to wean them from their cars, in precisely the reverse order we used to phase our teens into driving, has been torture for our parents and for us.

Toys – We have filled our parents’ shelves with new toys to help them with everything from opening cartons of milk (I would like a word with whoever designed those plastic pull loops) and zipping their clothes, to opening jars and removing the protective seals from over-the-counter medicines. A “picker-upper” device helps them avoid bending too low, and a key turner gives them leverage to open their door. Large digital clock faces, easy-to-read telephone keypads, and magnifying glasses keep them in touch with the world, and an e-mail printer keeps them in touch with their grandchildren.

Medicating – Filling those plastic pill box organizers with a week’s worth of medicines has become a personal barometer of competence for our parents, yet, as with our children when they were young, we feel compelled to oversee the dosing.

Mobility – Despite numerous falls, it was only with much teeth gnashing (or denture gnashing, as the case may be) that our mothers consented to use canes; more gnashing when canes gave way to walkers. For long walks, we hide the wheelchair half way there and back so the neighbors don’t see.

The more we do for our parents, the more frail and guilty they feel. Our efforts are sometimes resented. Helping them get in and out of the car, or bracing them under the arm as they negotiate a bumpy sidewalk, can be an affront. “I can do it myself!”

Can I ride my bike to tennis practice if I’m really careful crossing Holly Street? Why can’t I take a cab home from the seniors program at the community center? Can I walk to grandma’s by myself this time? Can I take the bus to the supermarket today? Everyone is hanging out at the park after school, can I go? I’ll just walk down the block to the neighbor’s house this afternoon, O.K.?

What wisdom did we gain the first time around to help us now? Patience, consciousness and white lies.

Patience to wait for them to come to the same conclusions we did. Mom, do you think Rosalind would have fallen and broken both wrists if she had been using a walker?

Consciousness about their need for independence as ballast to our need for their well-being. Why don’t you just let us drive you at night for now?

And white lies: I’m going to the supermarket anyway, we can shop together.

The longer we can protect our parents from harm, the more we can share our lives with them and the more joy they can have from their grandchildren. The trick is doing it without hurting them in other ways.

We have been through this before. It was worth it then, and it is worth it now.

Dr. Harley A. Rotbart is professor and vice chairman of pediatrics at the University of Colorado School of Medicine and the author of “No Regrets Parenting.”

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Clinton to Visit Israel in Effort to Defuse Gaza Conflict

PHNOM PENH, Cambodia — President Obama sent Secretary of State Hillary Rodham Clinton to the Middle East on Tuesday to try to defuse the conflict in Gaza, the White House announced.

Jason Reed/Reuters

Secretary of State Hillary Rodham Clinton and President Obama in Phnom Penh on Monday.

Mrs. Clinton, who accompanied Mr. Obama on his three-country Asia trip, left on her own plane immediately for the region, where she will stop first in Jerusalem to meet with Prime Minister Benjamin Netanyahu of Israel, then head to the West Bank to meet with Palestinian leaders and finally to Cairo to consult with Egyptian officials.

The decision to dispatch Mrs. Clinton dramatically deepens the American involvement in the crisis. Mr. Obama, on an Asian tour, made a number of late-night phone calls to the Middle East on Monday night that contributed to his conclusion that he had to become more engaged and that Mrs. Clinton might be able to accomplish something.

With the United Nations Secretary General Ban Ki-moon also scheduled to arrive in Israel on Tuesday, a senior official in the prime minister’s office said Israel decided to give more time to diplomacy before launching a ground invasion into Gaza. But Israel has not withdrawn other options.

“I prefer a diplomatic solution. I hope that we can get one but if not, we have every right to defend ourselves with other means and we shall use them,” Prime Minister Netanyahu said in a statement at the start of a meeting in Jerusalem with German Foreign Minister Guido Westerwelle.

“As you know, we seek a diplomatic unwinding to this, through the discussions of cease-fire,” Mr. Netanyahu added. “But if the firing continues we will have to take broader action, and we won’t hesitate to do so.”

The Health Ministry in Gaza said the death toll had climbed by late Tuesday morning to 112, roughly half of them civilians and including children. Three Israelis died in a rocket attack last week.After an Asian summit dinner in Phnom Penh on Monday night, Mr. Obama called President Mohamed Morsi of Egypt to discuss the situation, then spoke with Mr. Netanyahu and called Mr. Morsi back. He was up until 2:30 a.m. on the phone, the White House said. He consulted with Mrs. Clinton repeatedly on the sidelines of the Asian summit meetings on Tuesday.

“This morning, Secretary Clinton and the president spoke again about the situation in Gaza and the they agreed that it makes sense for the secretary to travel to the region so Secretary Clinton will depart today,” said Benjamin Rhodes, a deputy national security adviser to Mr. Obama. “Her visits will build on the engagement that we’ve undertaken in the last several days.”

Mr. Rhodes said that “any resolution to this has to include an end to that rocket fire” by Hamas militants on Israeli communities but “the best way to solve this is through diplomacy.”

He added: “It’s in nobody’s interest to see an escalation of the military conflict.”

Mrs. Clinton will not meet with Hamas representatives on her trip, but with leaders of the Palestinian leadership in the West Bank, which is at odds with the Hamas rulers of the Gaza Strip. “We do not engage directly with Hamas,” Mr. Rhodes said.

Instead, Mr. Obama is focused on leveraging Egypt’s influence with Hamas to press for a halt to the rocket attacks. “We believe Egypt can and should be a partner in achieving that outcome,” Mr. Rhodes said.

Mr. Rhodes reaffirmed that the United States supports Israel’s right to defend itself and said Mr. Obama did not ask Mr. Netanyahu to hold off a ground incursion into Gaza.

In Jerusalem, an official in the prime minister’s office said that the country’s top nine ministers, who make up the inner security cabinet, held discussions late into the night on the state of the diplomatic efforts and Israel’s military operation in Gaza. The goal of the operation, Israel says, is to end years of rocket fire by Gaza militants against southern Israel.

Egypt has been brokering efforts, with American involvement, for a cease-fire. “What is on the table is not there yet. It does not bring about what we need,” the official said, referring to Israel’s demands for an end to the threat of rocket fire.

Gaza militants fired more than 70 rockets in heavy barrages at southern Israel on Tuesday morning and 8 of them struck in densely populated areas.

Peter Baker reported from Phnom Penh, Cambodia, and Isabel Kershner from Jerusalem. Jodi Rudoren contributed reporting from Gaza City.

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Bits Blog: Intel Chief Executive to Retire in May

8:21 p.m. |Update

SAN FRANCISCO — After almost 40 years at Intel, its chief executive, Paul S. Otellini, is retiring, just as the company struggles with a momentous challenge: computing’s big shift to mobile devices.

Mr. Otellini, 62, surprised the technology world Monday by announcing that he would retire as an officer and director of the chip company this May, three years before he hits Intel’s mandatory retirement age. The board said it would immediately begin a search for a successor.

During a tenure that began in May 2005, Mr. Otellini established a strong track record. He increased Intel’s revenue 57 percent, to $55 billion at the end of 2011, and slightly widened its gross profit margin. Along the way, Mr. Otellini had to settle an antitrust suit for $1.25 billion, persuaded Apple to put Intel chips in its computers and cut 20,000 workers. Intel, the world’s largest semiconductor maker, now employs 100,000 people.

But the company’s share price has fallen about 20 percent in Mr. Otellini’s time. That is because the world of personal computers and computer servers, which Intel dominated partly through a close relationship with Microsoft, now competes with a global explosion of smartphones and tablets, which connect to large data centers. While Intel has some presence in these areas, it faces many new competitors and challenges, both to its business and to its way of thinking about products.

The right successor to Mr. Otellini, said Andrew Bryant, Intel’s chairman, would preserve Intel’s engineering-driven culture but turn it into an organization that is better able to anticipate rapidly changing consumer tastes.

“We don’t see the PC category going away, but we see that the market has changed,” Mr. Bryant said. “We need to figure out what the market wants.”

Mr. Otellini could not be reached for comment. In a statement issued by Intel, he said that “after almost four decades with the company and eight years as C.E.O., it’s time to move on and transfer Intel’s helm to a new generation of leadership.”

Last month Intel reported that its third-quarter net income fell 14.3 percent from a year earlier, to $3 billion, largely because of poor demand for PCs. The research firm IDC said that worldwide PC shipments fell 8.6 percent to 87.8 million units in the third quarter. Adding to the woes, Microsoft’s Windows 8 operating system, which Intel hoped would lift sales, was released in October to tepid reviews.

While they are both hurting from the PC plunge, Intel and Microsoft may be the best off of a troubled bunch. Last week, Advanced Micro Devices, Intel’s top competitor in chips for PCs, was forced to deny rumors that it was looking for a buyer. Its stock is down about 65 percent this year. Hewlett-Packard and Dell, both big PC makers, are also struggling.

Mr. Bryant said that Mr. Otellini had informed the board of his decision last Wednesday, citing a need for new leadership. He credited Mr. Otellini with putting Intel on track to produce chips that require less power. That is important both for battery-dependent smartphones and for data centers running hundreds of thousands of servers.

He also noted Mr. Otellini’s efforts in spearheading a category of lightweight laptop computers called ultrabooks, which have yet to take off in the market. Mr. Otellini also championed a wireless technology called WiMAX that never lived up to its billing.

Intel influences PC manufacturers in a number of ways. Besides designing and making the very core of their products, Intel also invests heavily in related fields; for example, through its venture arm it created a $300 million fund to promote ultrabooks. And it teaches its customers what they can do with each new generation of Intel chips, which in turn leads to new software development.

While Intel will look at both internal and external candidates, Mr. Bryant said, an internal candidate would probably prove a better fit, as that person would understand the culture. In its 45-year history, all of Intel’s five chief executives have been insiders.

Mr. Otellini’s departure is the third exit of a prominent executive from a major tech company in the last few weeks. In late October, Scott Forstall, who was the head of Apple’s mobile software development, was fired by Timothy D. Cook, the chief executive. Steven Sinofsky, the head of Windows at Microsoft, left the company a week ago, just after the introduction of Windows 8 and the Surface tablet. His brash personality led to internal clashes, and he and Steven A. Ballmer, Microsoft’s chief executive, agreed that it was time for him to go, according to a person briefed on the situation who was not authorized to speak publicly about it.

While both of those men were regarded as abrasive by those who worked with them, Mr. Otellini was not. A generally well-liked San Francisco native with an M.B.A. from Berkeley, Mr. Otellini was considered a break from Intel’s norm when he became chief because he was not formally trained in engineering.

But Ken Dulaney, an analyst with Gartner, drew a connection between the departures of the Microsoft and Intel executives.

“While Sinofsky and Otellini are gone for different reasons, underneath it similar forces are at work,” said. “Microsoft and Intel haven’t done a good job making PCs more compelling, and people are spending their dollars for electronics differently.”

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Responding to Illnesses Manifesting Amid Recovery From Storm

Nicole Bengiveno/The New York Times

Dr. Aaron Gardener, center, attended to a patient at an ad hoc medical unit in Long Beach, N.Y. Many people have coughs, rashes and other ailments.

Day and night, victims of Hurricane Sandy have been streaming into ad hoc emergency rooms and relief centers, like the MASH-type medical unit on an athletic field in Long Beach, and the warming tent in the Rockaways the size of a small high school gym.

They complain of rashes, asthma and coughing. They need tetanus shots because — house-proud and armed with survivalist instincts — they have been ripping out waterlogged boards and getting poked by rusty nails. Those with back pain from sifting through debris receive muscle relaxants; those with chest pain from overexertion are hooked up to cardiac monitors.

“I’ve been coughing,” said Gabriel McAuley, 46, who has been working 16-hour days gutting homes and hauling debris in the Rockaways since the storm hit. “I’ve never felt a cough like that before. It’s deeper down.”

It is impossible to say how many people have been sickened by what Hurricane Sandy left behind: mold from damp drywall; spills from oil tanks; sewage from floodwater and unflushable toilets; tons upon tons of debris and dust. But interviews with hurricane victims, recovery workers, health officials and medical experts over the last week reveal that some of the illnesses that they feared would occur, based on the toxic substances unleashed by the storm and the experience of other disasters, notably Hurricane Katrina, have begun to manifest themselves.

Emergency rooms and poison control centers have reported cases of carbon monoxide exposure — and in New Jersey, several deaths have been attributed to it — from the misuse of generators to provide power and stoves to provide heat.

In Livingston, N.J., the Burn Center at St. Barnabas Medical Center had 16 burn cases over about six days, three times as many as usual, from people trying to dispel the cold and darkness with boiling water, gasoline, candles and lighter fluid.

Raw sewage spilled into homes in Baldwin and East Rockaway, in Nassau County, when a sewage plant shut down because of the surge and the system could not handle the backup. Sewage also spilled from a huge plant in Newark. “We tried to limit our presence in the house because the stink was horrible,” said Jennifer Ayres, 34, of Baldwin, who has been staying temporarily in West Hempstead. She said that she felt ill for several days, that her son had a scratchy throat, and that her mother, who lives in the house, had difficulty breathing, all problems she attributed to the two days they spent inside their house cleaning up last week. “I had stomach problems. I felt itchy beyond itchy on my face.”

Coughing — locally known as the Rockaway cough — is a common symptom that health officials said could come from mold, or from the haze of dust and sand kicked up by the storm and demolitions. The air in the Rockaways is so full of particles that the traffic police wear masks — though many recovery workers do not, worrying people who recall the fallout of another disaster.

“It’s just like 9/11,” said Kathy Smilardi, sitting inside the skeleton of her gutted home in Broad Channel, wrapped in a white puffy jacket, her breath visible in the afternoon cold. “Everyone runs in to clean up, and they’re not wearing masks. Are we going to wait 20 years to figure out that people are dying?”

Health officials and experts say the risks are real, but are cautioning against hysteria. Some coughing could be due to cold, damp weather. Lasting health effects from mold, dust and other environmental hazards generally require long-term, continuous exposure, they said. And the short-term effects can be mitigated by taking precautions like wearing masks, gloves and boots and removing mold-infested wallboard. “The reality is that cleaning up both muck and sewage and spills and removing walls and reconstruction and dealing with debris all do in fact pose concerns,” Daniel Kass, New York City’s deputy commissioner for environmental health, said Friday. “Are they vast or uncontrollable? No. But they depend on people doing work correctly and taking basic precautions.”

The Katrina cough was found to be temporary, said Roy J. Rando, a professor at Tulane’s School of Public Health and Tropical Medicine. Felicia Rabito, an epidemiologist at the school, said that healthy children exposed to mold after Hurricane Katrina showed no lasting respiratory symptoms when they moved back to new or renovated homes.

Immediately after Hurricane Katrina, lead levels in New Orleans’s soil dropped after the top layers of dirt, where lead from paint and gasoline can accumulate, were washed away. But in the two years afterward, soil testing found extremely high lead levels, Dr. Rabito said, which she theorized came from renovating old homes. “That’s a cautionary tale,” she said. Lead in soil can be tracked into homes and pose a health hazard to children playing inside or outside.

Though at least one outbreak of norovirus, a contagious gastrointestinal virus, occurred in a Brooklyn high school that was used as a shelter, New York and New Jersey health officials said they had not seen any significant spike in respiratory or gastrointestinal diseases related to the storm.

In Broad Channel, most homes on Noel Road, where Ms. Smilardi lives, have outdoor oil tanks that were overturned by the storm. The innards of many homes, built when asbestos was used, lie spilled among major and minor roads.

Ominous red spots covered both sides of Paul Nowinski’s burly torso. After the storm, Mr. Nowinski, a musician, waded into the basement of his childhood home on Beach 146th Street in the Rockaways to try to salvage records, books and instruments. He was up to his chest in water, which he thinks might have been contaminated with sewage. He said that he did not know the cause of the red marks; and that he had been too busy “schlepping” to go to the doctor.

Angela Macropoulos contributed reporting.

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